Exhibitor Appointed Contractor Notification Form

Use this form to notify FSA Management that you are hiring an Independent Contractor.

Written request to use an Exhibitor Appointed Contractor must be submitted by the exhibiting company and received by FSA Management by May 16, 2025. All such requests are subject to approval by FSA Management. A request will not be approved if it is inconsistent with the commitments made and obligations assumed by FSA Management in any contract with the Official Service Contractor or its contract with the Breakers, West Palm Beach.

ALL REQUESTS MUST BE ACCOMPANIED BY A CERTIFICATE OF INSURANCE. INSURANCE CERTIFICATE MUST STATE THE NAME OF THE EXHIBITING COMPANY.
Company Information
Company Name
Contact Name
First Last
Telephone
Email
Exhibitor Appointed Contractor Information
Company Name
Contractor Name
First Last
Contractor Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Email
Services to be provided:
Please attach your Certificate of Insurance
Max. file size: 512 MB.
Certificate of Insurance can also be emailed to [email protected]
Name
This field is for validation purposes and should be left unchanged.

Company Information